The American journal of emergency medicine
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Comparative Study
A community-based comparison of trauma patient outcomes between D- and L-lactate fluids.
Ringer's lactate is used for patient resuscitation. Lactate naturally occurs in 2 stereoisometric forms, D- and L-lactate, that are added to fluid in equal amounts. Animal studies have demonstrated potentially deleterious effects of d-lactate on vital organs. Using an administrative database, we examined whether D- or L-lactate volume was associated with mortality in patients with trauma. ⋯ Because early administration of D-lactate was associated with mortality and ventilation, physicians and policy makers should recognize the advantages of L-lactate and encourage research on the quality of d- and l-lactate in case mixes beyond trauma.
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Takotsubo cardiomyopathy (TCM) is an underrecognized transient left ventricular dysfunction that mimics clinically an acute coronary syndrome. It has been linked to emotional stress and several clinical entities that provoke a catecholamine surge in the blood stream. We investigated the case of a young female patient who was admitted to the intensive care unit after a significant blood loss due to miscarriage. ⋯ As a result, TCM worsened further the general condition of the patient. There is a high possibility that TCM and hypovolemia can be closely related, and therefore, the treatment of hypovolemia can be adjusted to new standards. Because it has already been proved that TCM can be induced by emotional stress and various pathological entities, further investigations are necessary.
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Comparative Study
Comparison of risk scoring systems in predicting clinical outcome at upper gastrointestinal bleeding patients in an emergency unit.
Admission Rockall score (RS), full RS, and Glasgow-Blatchford Bleeding Score (GBS) can all be used to stratify the risk in patients presenting with upper gastrointestinal bleeding (UGIB) in the emergency department (ED). The aim of our study was to compare both admission and full RS and GBS in predicting outcomes at UGIB patients in a Romanian ED. ⋯ The GBS can be used to predict need for intervention and transfusion in patients with UGIB in our ED, whereas full RS can be successfully used to stratify the mortality risk in these patients.
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The aim of the present study was to determine whether quick diagnosis units (QDUs) can safely and efficiently avoid emergency department (ED) visits and hospitalizations. ⋯ An increasing number of PC and ED patients were referred to the QDU. Hospitalizations might have been avoided in at least 84% of patients. Although QDU and hospitalization are similarly effective in reaching a diagnosis, the QDU model incurs fewer costs.
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The most frequent cardiac pathologies caused by electric shock are arrhythmias with a wide clinical picture ranging from sinus tachycardia to asystole. Cardiac mechanical complications secondary to electric shock have rarely been reported. ⋯ In this study, we have presented the rupture in the secondary chordae of the mitral anterior leaflet caused by low-voltage electrical trauma. To our knowledge, this is the first cardiac mechanical complication reported as a consequence of low-tension electrical trauma.